Alternatives to drugs for managing pain

Dr Ann Robinson (Prescribing for pain is out of control. Doctors need new tools, 16 September) speaks eloquently about the limitations of drugs and the difficulties GPs have in managing patients with long-term pain. However, I remain amazed that she does not mention the use of hypnosis techniques to manage chronic pain.

In the field of pain management, there is a huge body of research demonstrating how effective hypnosis can be. All over the world, hypnosis is used for pain control by health professionals, while in the UK it remains marginalised and underfunded, although millions are spent on ineffective drugs and people continue to suffer.

As an NHS GP and a member of the British Society of Clinical and Academic Hypnosis, I was able to treat chronic pain in many of my patients using hypnosis. Am I being a bit cynical, but could it be because there’s no profit to be made in this non-drug treatment?
Dr Maureen Tilford
London

• Ann Robinson’s article on the crisis in medical treatment of pain mentions acupuncture. But other natural treatments such as chiropractic and osteopathy, and even unfashionable homeopathy, have an important contribution to make. There is good scientific evidence that they can help with pain. An article in the BMJ states: “Complementary and integrative medicine offers a multimodality treatment approach that can tackle the multidimensional nature of pain with fewer or no serious adverse effects.”

This is a crisis and it is time for open-mindedness and tolerance, not dogma and prejudice against alternatives, which is all too common now. Funding should be available for therapies that people know work for them. The Royal College of General Practitioners has issued a statement saying as much: “GPs need better access for our patients to alternative therapies in the community.”
Peter Adams
Edge, Gloucestershire

• At the recent British Society for Population Studies meeting on “Stalling Life Expectancy”, I saw the evidence that the UK has now seen a fall in life expectancy. In 2015, the US researcher and Nobel laureate Angus Deaton reported this fall in America. A key factor there is known as the “deaths of despair”, including overdoses on prescription painkillers. Potentially there are many things in British society that could drive individuals to despair, including the impoverishment of whole communities or the breakdown of community safety and solidarity. The increase in deaths is concentrated in certain poorer areas of both countries, representing the end point of many health inequalities.

Pain (and pills) will always be with us, so responsible prescribers will have to find ways of addressing despair to help their patients survive, and responsible policymakers need urgently to address addiction to help whole communities survive.
Prof Woody Caan
Editor, Journal of Public Mental Health

• Many clinicians have been aware for a long time of the problem of addiction to prescribed medication (One in four adults take pills they may find hard to stop, 10 September). We are trying to avoid new patients becoming habituated by encouraging them to taper off slowly after an appropriate period of treatment, though it isn’t always easy. Many are in difficult personal situations, such as poverty, poor housing and domestic violence, and trying to reduce medication when the triggers are still present is hard. Social prescribing is great but depends on local resources, mostly voluntary. It needs the government to act in a long-term, joined-up way.

The bigger problem is people who have been on these medications for decades, and who might like to taper off but fear the effects. Since mainstream substance misuse services were moved to local government and massively underfunded, they cannot cope with their current population. I’m not sure older people taking prescribed medication would want to share their waiting rooms.

It is a problem that will get worse with older people being at increased risk of falls. There needs to be an integrated service dealing with both medical and social needs, as for all older people. Will this happen soon?
Dr Michael Peel
Axbridge, Somerset

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